Aerosol therapy in adult critically ill patients: a consensus statement regarding aerosol administration strategies during various modes of respiratory support

Annals of Intensive Care

Research

Paolo Pelosi¹  Stephan Ehrmann²  Jordi Rello³  Shan Lyu⁴  Jie Li⁵  James B. Fink⁶  Guoqiang Jing⁷  Kai Liu⁸  Qin Lu⁹  Rajiv Dhand^1,10  Armèle Dornelas de Andrade^1,11  Hui-Ling Lin^1,12  Bing Dai^1,13  Charles-Edouard Luyt^1,14  Laurent Vecellio^1,15  Ariel Berlinski^1,16  Jean-Jacques Rouby^1,17  Jean-Bernard Michotte^1,18  Gregory Reychler^1,19  Antoni Torres^2,20 

[1] Anesthesiology and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy;Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy;CHRU Tours, Médecine Intensive Réanimation, CIC INSERM 1415, CRICS-TriggerSep F-CRIN Research Network, and INSERM, Centre d’étude des Pathologies Respiratoires, U1100, Université de Tours, Tours, France;Clinical Research/Epidemiology in Pneumonia and Sepsis (CRIPS), Vall d’Hebron Institute of Research (VHIR), Barcelona, Spain;Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain;Clinical Research in the ICU, Anaesthesia Department, CHU Nimes, Université de Nimes-Montpellier, Nimes, France;Critical Care Medicine, Peking University People’s Hospital, Beijing, China;Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, 600 S Paulina St, Suite 765, 60612, Chicago, IL, USA;Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, 600 S Paulina St, Suite 765, 60612, Chicago, IL, USA;Chief Science Officer, Aerogen Pharma Corp, San Mateo, CA, USA;Department of Critical Care Medicine, Binzhou Medical University Hospital, Binzhou, China;Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China;Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, and Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China;Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA;Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Brazil;Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan;Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China;Médecine Intensive Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Sorbonne-Université, and INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France;PST-A, Faculté de Médecine, Université de Tours, Tours, France;Pulmonary and Sleep Medicine Division, Department of Pediatrics, University of Arkansas for Medical Sciences, and Pediatric Aerosol Research Laboratory at Arkansas Children’s Research Institute, Little Rock, AR, USA;Research Department DMU DREAM and Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Sorbonne University of Paris, Paris, France;School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland;Secteur de Kinésithérapie et Ergothérapie, Cliniques Universitaires Saint-Luc, Brussels, Belgium;Service de Pneumologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium;Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL and Dermatologie, Université Catholique de Louvain, Brussels, Belgium;Servei de Pneumologia, Hospital Clinic, University of Barcelona, IDIBAPS CIBERES, Icrea, Barcelona, Spain;Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain;

关键词: ;   

DOI  :  10.1186/s13613-023-01147-4

 received in 2023-04-09, accepted in 2023-05-31,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundClinical practice of aerosol delivery in conjunction with respiratory support devices for critically ill adult patients remains a topic of controversy due to the complexity of the clinical scenarios and limited clinical evidence.ObjectivesTo reach a consensus for guiding the clinical practice of aerosol delivery in patients receiving respiratory support (invasive and noninvasive) and identifying areas for future research.MethodsA modified Delphi method was adopted to achieve a consensus on technical aspects of aerosol delivery for adult critically ill patients receiving various forms of respiratory support, including mechanical ventilation, noninvasive ventilation, and high-flow nasal cannula. A thorough search and review of the literature were conducted, and 17 international participants with considerable research involvement and publications on aerosol therapy, comprised a multi-professional panel that evaluated the evidence, reviewed, revised, and voted on recommendations to establish this consensus.ResultsWe present a comprehensive document with 20 statements, reviewing the evidence, efficacy, and safety of delivering inhaled agents to adults needing respiratory support, and providing guidance for healthcare workers. Most recommendations were based on in-vitro or experimental studies (low-level evidence), emphasizing the need for randomized clinical trials. The panel reached a consensus after 3 rounds anonymous questionnaires and 2 online meetings.ConclusionsWe offer a multinational expert consensus that provides guidance on the optimal aerosol delivery techniques for patients receiving respiratory support in various real-world clinical scenarios.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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